Estudio comparativo entre un test de antígeno y la prueba de la reacción en cadena de la polimerasa en tiempo real (RT-PCR) para el diagnóstico de infección por COVID-19 en pediatría / Comparative study between an antigen test and the reverse transcription-polymerase chain reaction (RT-PCR) test for the diagnosis of COVID-19 in pediatrics

Introducción. La pandemia por COVID-19 ha puesto de manifiesto la necesidad de pruebas diagnósticas rápidas. La prueba de referencia es la reacción en cadena de la polimerasa en tiempo real (RT-PCR). Requiere un equipo y personal capacitado, y su resultado puede llevar un tiempo de espera prolongado. El sistema BD Veritor® es el método rápido cromatográfico utilizado para la detección del antígeno del coronavirus de tipo 2 del síndrome respiratorio agudo grave, en individuos sintomáticos. El objetivo primario del siguiente trabajo es evaluar sensibilidad y especificidad del test de antígeno (TA) comparadas con la RT-PCR en población pediátrica. Población y métodos. Estudio prospectivo, de prueba diagnóstica. Se incluyó a todo menor de 17 años en los primeros 5 días de inicio de síntomas, que consultó desde julio de 2021 hasta febrero de 2022. Se calculó un mínimo de 300 muestras para lograr una precisión de ± 8,76 % y de ± 3,68 % para sensibilidad y especificidad respectivamente. Se analizaron en paralelo las muestras por ambas metodologías. Resultados. De 316 muestras pareadas, 33 fueron positivas por ambos métodos; 6 fueron positivas solo por RT-PCR. La especificidad del TA fue del 100 %; la sensibilidad, del 84,6 %, con un valor predictivo positivo y negativo del 100 % y del 98 % respectivamente. Conclusiones. El TA demostró ser útil en el diagnóstico de pacientes pediátricos con COVID-19 en los primeros 5 días de inicio de síntomas, aunque aquellos con TA negativo y alta sospecha clínica deberían confirmar su resultado con la RT-PCR.

Introduction. The COVID-19 pandemic has brought to light the need for rapid diagnostic tests. The gold standard test is reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR requires equipment and trained personnel, and results may take a long waiting time. The BD Veritor® System is a rapid chromatographic method used for the detection of severe acute respiratory syndrome coronavirus 2 antigen in symptomatic individuals. The primary objective of this study is to assess the sensitivity and specificity of the antigen test (AT) compared to the RT-PCR in the pediatric population. Population and methods. Prospective study with a diagnostic test. All children younger than 17 years in the first 5 days of symptom onset, who consulted between July 2021 and February 2022, were included. A minimum of 300 specimens was estimated to achieve an accuracy of ±8.76% and ±3.68% for sensitivity and specificity, respectively. Specimens were analyzed in parallel using both methodologies. Results. Of 316 paired samples, 33 were positive by both methods; 6 were positive only by RT-PCR. The specificity of the AT was 100%; sensitivity was 84.6%, with a positive and negative predictive value of 100% and 98%, respectively. Conclusions. The AT proved to be useful in the diagnosis of pediatric patients with COVID-19 in the first 5 days of symptom onset, although those with a negative AT and high clinical suspicion should confirm their result with a RT-PCR.

Comparative study between an antigen test and the reverse transcription-polymerase chain reaction (RT-PCR) test for the diagnosis of COVID-19 in pediatrics. / Estudio comparativo entre un test de antígeno y la prueba de la reacción en cadena de la polimerasa en tiempo real (RT-PCR) para el diagnóstico de infección por COVID-19 en pediatría.

Introduction. The COVID-19 pandemic has brought to light the need for rapid diagnostic tests. The gold standard test is reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR requires equipment and trained personnel, and results may take a long waiting time. The BD Veritor® System is a rapid chromatographic method used for the detection of severe acute respiratory syndrome coronavirus 2 antigen in symptomatic individuals. The primary objective of this study is to assess the sensitivity and specificity of the antigen test (AT) compared to the RT-PCR in the pediatric population. Population and methods. Prospective study with a diagnostic test. All children younger than 17 years in the first 5 days of symptom onset, who consulted between July 2021 and February 2022, were included. A minimum of 300 specimens was estimated to achieve an accuracy of ±8.76% and ±3.68% for sensitivity and specificity, respectively. Specimens were analyzed in parallel using both methodologies. Results. Of 316 paired samples, 33 were positive by both methods; 6 were positive only by RT-PCR. The specificity of the AT was 100%; sensitivity was 84.6%, with a positive and negative predictive value of 100% and 98%, respectively. Conclusions. The AT proved to be useful in the diagnosis of pediatric patients with COVID-19 in the first 5 days of symptom onset, although those with a negative AT and high clinical suspicion should confirm their result with a RT-PCR. Clinical trial registration: PRIISA.BA - Record number: 4912 - Date of registration: 07/07/2021.

Introducción. La pandemia por COVID-19 ha puesto de manifiesto la necesidad de pruebas diagnósticas rápidas. La prueba de referencia es la reacción en cadena de la polimerasa en tiempo real (RT-PCR). Requiere un equipo y personal capacitado, y su resultado puede llevar un tiempo de espera prolongado. El sistema BD Veritor® es el método rápido cromatográfico utilizado para la detección del antígeno del coronavirus de tipo 2 del síndrome respiratorio agudo grave, en individuos sintomáticos. El objetivo primario del siguiente trabajo es evaluar sensibilidad y especificidad del test de antígeno (TA) comparadas con la RT-PCR en población pediátrica. Población y métodos. Estudio prospectivo, de prueba diagnóstica. Se incluyó a todo menor de 17 años en los primeros 5 días de inicio de síntomas, que consultó desde julio de 2021 hasta febrero de 2022. Se calculó un mínimo de 300 muestras para lograr una precisión de ± 8,76 % y de ± 3,68 % para sensibilidad y especificidad respectivamente. Se analizaron en paralelo las muestras por ambas metodologías. Resultados. De 316 muestras pareadas, 33 fueron positivas por ambos métodos; 6 fueron positivas solo por RT-PCR. La especificidad del TA fue del 100 %; la sensibilidad, del 84,6 %, con un valor predictivo positivo y negativo del 100 % y del 98 % respectivamente. Conclusiones. El TA demostró ser útil en el diagnóstico de pacientes pediátricos con COVID-19 en los primeros 5 días de inicio de síntomas, aunque aquellos con TA negativo y alta sospecha clínica deberían confirmar su resultado con la RT-PCR. Registro de ensayos clínicos: PRIISA.BA ­ Número de registro: 4912 ­ Fecha de inscripción: 07/07/2021.

Direct costs and clinical impact of adenovirus genotype 8 conjunctivitis outbreak in a neonatology unit.

OBJECTIVE: To report a conjunctivitis outbreak in a neonatology intensive care unit (NICU) and determine the associated economic impact. DESIGN: Prospective observational study. SETTING: Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, a private, tertiary-care healthcare institution in Buenos Aires, Argentina. PARTICIPANTS: The study included 52 NICU neonates and 59 NICU-related healthcare workers (HCWs) from CEMIC hospital. METHODS: Neonates and HCWs were swabbed for real-time polymerase chain reaction (PCR) testing, viral culture, and typing by sequencing. Infection control measures, structural and logistic changes were implemented. Billing records were analyzed to determine costs. RESULTS: From January 30 to April 28, 2018, 52 neonates were hospitalized in the NICU. Among them, 14 of 52 (21%) had bilateral conjunctivitis with pseudomembranes. Symptomatic neonates and HCWs were HAdV-D8 positive. Ophthalmological symptoms had a median duration of 18 days (IQR, 13-24.5). PCR positivity and infectious range had a median duration of 18.5 days. As part of containment measures, the NICU and the high-risk pregnancy unit were closed to new patients. The NICU was divided into 2 areas for symptomatic and asymptomatic patients; a new room was assigned for the general nursery, and all deliveries from the high-risk pregnancy unit were redirected to other hospitals. The outbreak cost the hospital US$205,000: implementation of a new nursery room and extra salaries cost US$30,350 and estimated productivity loss during 1 month cost US$175,000. CONCLUSIONS: Laboratory diagnosis confirmed the cause of this outbreak as HAdV-D8. The immediate adoption and reinforcement of rigorous infection control measures limited the nosocomial viral spread. This outbreak represented a serious institutional problem, causing morbidity, significant economic loss, and absenteeism.

[Epidemiology and risk factors for prolonged hospital length of stay in children with leukemia and bacteremia. Cohort study]. / Epidemiología y factores de riesgo de internación prolongada en niños con leucemia y bacteriemia. Estudio de cohorte.

INTRODUCTION: Bacteremia is a frequent complication in children with cancer, which is associated with greater severity, prolonged hospitalization and mortality. Prolonged hospitalization conditions greater morbidity and risk of acquisition of intranosocomial infections. AIM: To describe risk factors for prolonged hospital length of stay in children with leukemia and bacteremia. METHODS: Cohort study. Episodes of bacteremia in patients with leukemia at Garrahan Hospital from 1/1/2015 to 31/12/2016 were reviewed. We compared data from patients with a LOS of 14 days or more with those admitted for less than 14 days. Bivariate and logistic regression analysis was performed. We used Stata 13 statistical package. RESULTS: n = 121. Median age 59 months.81 patients (67%) had a diagnosis of acute lymphoblastic leukemia, followed by acute myeloid leukemia in 40 (33%). 96 patients (79%) had a central venous catheter (CVC), 94 patients (78%) were neutropenic. Blood cultures were positive for Enterobacteriaceae in 55 cases (45%), coagulase-negative staphylococci in 28 cases (23%), Group viridans Streptococcus in 19 (16%), Pseudomonas aeruginosa in 8 (7%). (9%). By the multivariate analysis, three factors remained significantly associated with length of stay of more than 14 days: CVC associated bacteremia (OR 21,73; CI95% 1.2-43.2; p 0.04), severe neutropenia (OR 1.75; CI95% 1.82-1.28; p 0.03) and coinfection (OR 27.4; CI95% 2.8-260.8; p 0.004). CONCLUSION: CVC associated bacteremia, severe neutropenia and viral coinfection were associated with hospital LOS of more than 14 days.

Risk factors for the appearance of secondary foci of infection in children with community-acquired Staphylococcus aureus bacteraemia. Cohort study 2010-2016. / Factores de riesgo de focos secundarios de infección en niños con bacteriemia por Staphylococcus aureus adquirida en la comunidad. Estudio de cohorte 2010-2016.

INTRODUCTION: Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hospitalisation in children. The occurrence of secondary foci (SF) of SA infection is associated with higher morbidity and mortality. OBJECTIVES: To identify risk factors for SF of infection in children with community-acquired SA bacteraemia. MATERIAL AND METHODS: Prospective cohort. All children aged from 30 days to 16 years admitted to a paediatric referral hospital between January 2010 and December 2016 for community-acquired infections, with SA isolated in blood cultures, were included. Microbiological, demographic and clinical characteristics were compared, with or without SF infection after 72hours of hospitalisation. RESULTS: A total of 283 patients were included, 65% male (n=184), with a median age of 60 months (IQR: 30-132). Seventeen per cent (n=48) had at least one underlying disease and 97% (n=275) had some clinical focus of infection, the most common being: osteoarticular 55% (n=156) and soft tissue abscesses 27% (n=79). A total of 65% (n=185) were resistant to methicillin. A SF of infection was found in 16% of patients (n=44). The SF identified were pneumonia 73% (n=32), osteoarticular 11% (n=5), soft tissue 11% (n=5) and central nervous system 5% (n=2). In the multivariate analysis, the persistence of positive blood cultures after the fifth day (OR: 2.40, 95%CI: 1.07-5.37, P<0.001) and sepsis (OR: 17.23, 95%CI 5.21-56.9, P<0.001) were predictors of SF. There was no association with methicillin sensitivity. CONCLUSIONS: In this cohort, methicillin-resistant SA infections predominated. The occurrence of SF of infection was associated with the persistence of bacteraemia after the fifth day and sepsis on admission.

Epidemiología y factores de riesgo de internación prolongada en niños con leucemia y bacteriemia: estudio de cohorte / Epidemiology and risk factors for prolonged hospital length of stay in children with leukemia and bacteremia: cohort study

Resumen Introducción: La bacteriemia constituye una complicacion frecuente en los niños con cáncer, que se asocia a mayor gravedad, internación prolongada y mortalidad. La internación prolongada condiciona mayor morbilidad y riesgo de adquisición de infecciones intranosocomiales. Objetivo: Analizar factores de riesgo de internación prolongada en niños con leucemia y bacteriemia. Pacientes y Métodos: Cohorte retrospectiva. Se incluyeron niños con leucemia internados en el Hospital Garrahan entre 1/1/2015 y 31/12/2016 con bacteriemia. Se compararon características de pacientes con internaciones menores o mayores a 14 días. Se realizó un análisis bivariado y modelo de regresión logística. Se utilizó Stata 13. Resultados: n = 121. Mediana de edad 59 meses. Tenían leucemia linfoblastica 81 pacientes (67%) y leucemia mieloblástica 40 (33%). Tenían catéter venoso central (CVC) 96 de los niños (79%), neutropenia 94 (78%), neutropenia menor a 100 neutrófilos 79 (65%). La identificación en hemocultivos fue: 55 casos (45%) enterobacterias, 28 (23%) Staphylococcus coagulasa negativa, Streptococcus spp grupo viridans 19 (16%), Pseudomonas aeruginosa 8 (7%). Huo co-infección viral en 14 pacientes (12%).Tuvieron menos de 14 días de internación 71 pacientes (59%) y mayor período 50 (41%). En el análisis multivariado la bacteriemia asociada a CVC (OR 21,73; IC95% 1,2-43,20; p 0,04), neutropenia profunda al ingreso (OR 1,75; IC95% 1,82-1,28; p 0,03) y co-infección viral (OR 27,42; IC95% 2,88-260,83; p 0,004) fueron factores de riesgo de internación > 14 días. Conclusiones: La bacteriemia asociada a CVC, la neutropenia profunda al ingreso y la co-infección se asociaron con una internación igual o mayor a 14 días.

ABSTRACT Introduction: Bacteremia is a frequent complication in children with cancer, which is associated with greater severity, prolonged hospitalization and mortality. Prolonged hospitalization conditions greater morbidity and risk of acquisition of intranosocomial infections. Aim: To describe risk factors for prolonged hospital length of stay in children with leukemia and bacteremia. Methods: Cohort study. Episodes of bacteremia in patients with leukemia at Garrahan Hospital from 1/1/2015 to 31/12/2016 were reviewed. We compared data from patients with a LOS of 14 days or more with those admitted for less than 14 days. Bivariate and logistic regression analysis was performed. We used Stata 13 statistical package. Results: n = 121. Median age 59 months.81 patients (67%) had a diagnosis of acute lymphoblastic leukemia, followed by acute myeloid leukemia in 40 (33%). 96 patients (79%) had a central venous catheter (CVC), 94 patients (78%) were neutropenic. Blood cultures were positive for Enterobacteriaceae in 55 cases (45%), coagulase-negative staphylococci in 28 cases (23%), Group viridans Streptococcus in 19 (16%), Pseudomonas aeruginosa in 8 (7%). (9%). By the multivariate analysis, three factors remained significantly associated with length of stay of more than 14 days: CVC associated bacteremia (OR 21,73; CI95% 1.2-43.2; p 0.04), severe neutropenia (OR 1.75; CI95% 1.82-1.28; p 0.03) and coinfection (OR 27.4; CI95% 2.8-260.8; p 0.004). Conclusion: CVC associated bacteremia, severe neutropenia and viral coinfection were associated with hospital LOS of more than 14 days.

Endocarditis por Streptococcus pneumoniae en pediatría. Presentación de un caso clínico / Streptococcus pneumoniae endocarditis in a child: a case report

Resumen Introducción: la incidencia de infecciones invasivas por neumococo ha disminuido desde la genera lización de la vacuna neumocóccica conjugada, aunque el neumococo continúa siendo un patógeno prevalente en niños. De las infecciones invasivas por neumococo, la EI (endocarditis infecciosa) es una forma de presentación rara con una incidencia de 1 a 7%. Caso clínico: Presentamos el caso de un niño de 4 años previamente sano, con una única dosis de vacuna 10 valente conjugada para neu mococo, que consulta con fiebre, la aparición de un nuevo soplo cardíaco e insuficiencia cardíaca. Presentó desarrollo de S. pneumoniae en hemocultivos, sensible a penicilina. En el ecocardiograma transtorácico se observaron vegetaciones en válvula tricuspídea y pulmonar. Recibió 4 semanas de tratamiento antibiótico con diagnóstico de EI por neumococo. Evolucionó con daño valvular secun dario que requirió tratamiento quirúrgico. Conclusiones: Debe considerarse la EI como diagnóstico diferencial ante todo niño febril con la aparición de un nuevo soplo cardíaco, y al neumococo agente etiológico en los pacientes febriles con infecciones graves provenientes de la comunidad.

Abstract Introduction: the incidence of invasive infections caused by pneumococcus (Streptococcus pneumoniae) has declined since generalized vaccination with pneumococcal conjugated vaccine, but it is still a prevalent pathogen in children. Amongst pneumococcal invasive infections, IE (infectious endocarditis) is rare, with an incidence between 1 and 7%. Case report: We describe the case of a previously healthy 4 year old boy, who had received one dose of 10-valent pneumococcal conjugate vaccine who presents with fever, a new heart murmur and heart failure. Blood cultures were posi tive for penicillin susceptible pneumococcus. The transthoracic echocardiogram showed tricuspid and pulmonary valve vegetations. The patient received 4 weeks of antibiotic treatment for pneumo-coccal IE. He presented secondary valve damage that needed surgical treatment. Conclusions: IE should be considered as a differential diagnosis of children presenting with fever and a newly diag nosed heart murmur, and pneumococcus as an etiologic agent in non hospitalized febrile patients with severe infections.

Sepsis secundaria a infección urinaria asociada a sonda vesical por Trichosporon asahii en una unidad pediátrica de quemados: reporte de 2 casos / Trichosporon asahii sepsis associated with urinary catheter in a pediatric burn unit: 2 case reports

Trichosporon asahii es un hongo ubicuo que se ha aislado como parte de la microbiota humana. Recientemente, se ha visto una emergencia de este patógeno en infecciones tanto localizadas como sistémicas. En unidades de cuidados intensivos pediátricos para quemados, existen escasos reportes de infecciones del tracto urinario por este microorganismo. Se describen 2 pacientes pediátricos con internación prolongada por quemaduras extensas y múltiples tratamientos antibióticos previos. Ambos presentaron sepsis por infección del tracto urinario asociada a sonda vesical por Trichosporon asahii. En ambos pacientes, se realizó el recambio de la sonda vesical y tratamiento con voriconazol por 10 días, con buena evolución. En los casos presentados, debido a la ausencia de otros aislamientos microbiológicos y a la buena respuesta al tratamiento antifúngico junto con el recambio de la sonda vesical, se asumió al Trichosporon asahii como el probable agente causal de la sepsis.

Trichosporon asahii is a ubiquitous fungus that has been isolated as part of human microbiota. There has been an emergence of this pathogen in recent years, causing superficial and deep seated infections. There are scarce reports of urinary tract infections in pediatric intensive care burn units caused by this agent. We describe the cases of 2 pediatric patients with prolonged hospitalization due to severe burns that had received several antibiotic courses for previous infections. Both presented sepsis secondary to catheter related urinary tract infection by Trichosporon asahii. Both patients underwent urinary catheter replacement and were treated effectively with voriconazole for 10 days. In the cases presented, sepsis was assumed to be due to Trichosporon asahii since no other microorganism was identified and the patients showed favorable outcome with the prescribed treatment with voriconazole and replacement of the urinary catheter.

[Trichosporon asahii sepsis associated with urinary catheter in a pediatric burn unit: 2 case reports]. / Sepsis secundaria a infección urinaria asociada a sonda vesical por Trichosporon asahii en una unidad pediátrica de quemados: reporte de 2 casos.

Trichosporon asahii is a ubiquitous fungus that has been isolated as part of human microbiota. There has been an emergence of this pathogen in recent years, causing superficial and deep seated infections. There are scarce reports of urinary tract infections in pediatric intensive care burn units caused by this agent. We describe the cases of 2 pediatric patients with prolonged hospitalization due to severe burns that had received several antibiotic courses for previous infections. Both presented sepsis secondary to catheter related urinary tract infection by Trichosporon asahii. Both patients underwent urinary catheter replacement and were treated effectively with voriconazole for 10 days. In the cases presented, sepsis was assumed to be due to Trichosporon asahii since no other microorganism was identified and the patients showed favorable outcome with the prescribed treatment with voriconazole and replacement of the urinary catheter.

Trichosporon asahii es un hongo ubicuo que se ha aislado como parte de la microbiota humana. Recientemente, se ha visto una emergencia de este patógeno en infecciones tanto localizadas como sistémicas. En unidades de cuidados intensivos pediátricos para quemados, existen escasos reportes de infecciones del tracto urinario por este microorganismo. Se describen 2 pacientes pediátricos con internación prolongada por quemaduras extensas y múltiples tratamientos antibióticos previos. Ambos presentaron sepsis por infección del tracto urinario asociada a sonda vesical por Trichosporon asahii. En ambos pacientes, se realizó el recambio de la sonda vesical y tratamiento con voriconazol por 10 días, con buena evolución. En los casos presentados, debido a la ausencia de otros aislamientos microbiológicos y a la buena respuesta al tratamiento antifúngico junto con el recambio de la sonda vesical, se asumió al Trichosporon asahii como el probable agente causal de la sepsis.

Anidulafungina en niños: experiencia de un hospital pediátrico de tercer nivel en Argentina / Ánidulafungin in children: Experience in a tertiary care children's hospital in Argentina

La experiencia con anidulafungina en el tratamiento de infecciones fúngicas invasivas en pediatría es escasa. Se presenta nuestra experiencia en 55 niños. La anidulafungina se administró por vía intravenosa en la dosis de carga de 3 mg/kg en una sola dosis diaria, seguida de 1,5 mg/kg cada 24 h durante una media de 14 días (rango, 7-22 d.). La mediana de edad de los pacientes fue de 114 meses (rango intercuartíhco, 32168 m.). Todos los pacientes tenían enfermedades subyacentes. En los trasplantados de médula ósea, la diferencia entre el valor inicial y al final de la administración del fármaco en el recuento de glóbulos blancos, valores de transaminasas y función renal no fue significativo. Ninguno de los pacientes tuvo eventos adversos o murió por causas relacionadas con anidulafungina. La anidulafungina podría ser una opción para la profilaxis o el tratamiento de las infecciones fúngicas invasivas en pediatría, aunque se requieren estudios metodológicamente sólidos para probarlo.

The experience using anidulafungin for the treatment of invasive fungal infections in pediatrics is limited. In this article, we describe our experience in 55 children. Anidulafungin was administered intravenously at a loading dose of 3 mg/kg once daily, followed by 1.5 mg/kg every 24 hours over a mean period of 14 days (range: 7-22 days). Patients' median age was 114 months old (interquartile range: 32-168 months old). All patients had underlying diseases. Among patients with bone marrow transplant, the difference in white blood cell count, transaminase levels, and renal function at baseline and at the end of anidulafungin administration was not significant. No adverse events were reported and no patient died from an anidulafungin-related cause. Anidulafungin may be considered an alternative for the prophylaxis or treatment of invasive fungal infections in pediatrics but methodologically robust studies are needed to confirm this.

Anidulafungin in children: Experience in a tertiary care children's hospital in Argentina. / Anidulafungina en niños: experiencia de un hospital pediátrico de tercer nivel en Argentina.

The experience using anidulafungin for the treatment of invasive fungal infections in pediatrics is limited. In this article, we describe our experience in 55 children. Anidulafungin was administered intravenously at a loading dose of 3 mg/kg once daily, followed by 1.5 mg/kg every 24 hours over a mean period of 14 days (range: 7-22 days). Patients' median age was 114 months old (interquartile range: 32-168 months old). All patients had underlying diseases. Among patients with bone marrow transplant, the difference in white blood cell count, transaminase levels, and renal function at baseline and at the end of anidulafungin administration was not significant. No adverse events were reported and no patient died from an anidulafungin-related cause. Anidulafungin may be considered an alternative for the prophylaxis or treatment of invasive fungal infections in pediatrics but methodologically robust studies are needed to confirm this.

La experiencia con anidulafungina en el tratamiento de infecciones fúngicas invasivas en pediatría es escasa. Se presenta nuestra experiencia en 55 niños. La anidulafungina se administró por vía intravenosa en la dosis de carga de 3 mg/kg en una sola dosis diaria, seguida de 1,5 mg/kg cada 24 h durante una media de 14 días (rango, 7-22 d.). La mediana de edad de los pacientes fue de 114 meses (rango intercuartílico, 32-168 m.). Todos los pacientes tenían enfermedades subyacentes. En los trasplantados de médula ósea, la diferencia entre el valor inicial y al final de la administración del fármaco en el recuento de glóbulos blancos, valores de transaminasas y función renal no fue significativo. Ninguno de los pacientes tuvo eventos adversos o murió por causas relacionadas con anidulafungina. La anidulafungina podría ser una opción para la profilaxis o el tratamiento de las infecciones fúngicas invasivas en pediatría, aunque se requieren estudios metodológicamente sólidos para probarlo.

[Streptococcus pneumoniae endocarditis in a child: a case report]. / Endocarditis por Streptococcus pneumoniae en pediatría. Presentación de un caso clínico.

INTRODUCTION: the incidence of invasive infections caused by pneumococcus (Streptococcus pneumoniae) has declined since generalized vaccination with pneumococcal conjugated vaccine, but it is still a prevalent pathogen in children. Amongst pneumococcal invasive infections, IE (infectious endocarditis) is rare, with an incidence between 1 and 7%. CASE REPORT: We describe the case of a previously healthy 4 year old boy, who had received one dose of 10-valent pneumococcal conjugate vaccine who presents with fever, a new heart murmur and heart failure. Blood cultures were posi tive for penicillin susceptible pneumococcus. The transthoracic echocardiogram showed tricuspid and pulmonary valve vegetations. The patient received 4 weeks of antibiotic treatment for pneumo-coccal IE. He presented secondary valve damage that needed surgical treatment. CONCLUSIONS: IE should be considered as a differential diagnosis of children presenting with fever and a newly diag nosed heart murmur, and pneumococcus as an etiologic agent in non hospitalized febrile patients with severe infections.

Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids.

INTRODUCTION: Adenotonsillectomy is the most common surgical procedure in otolaryngology.The main indication for this procedure is upper airway obstruction associated with hypertrophic tonsils and/or adenoids. OBJECTIVES: To describe the differences in quality of life before and after an adenoidectomy and/or tonsillectomy and compare it with that of healthy children. POPULATION AND METHODS: All children aged 1 to 17 years old hospitalized for an elective surgery between July 2012 and April 2014 were enrolled.They were compared to a control group of children in the same age range. The survey used was validated in Spanish (OSA-18) and has been especially designed to establish a relationship between obstructive sleep apnea and quality of life in pediatrics. RESULTS: Eighty-five surgery patients and 100 healthy control children were assessed. The impact on quality of life was mild in 37.6% of children, moderate in 32.9%, and severe in 29.4%,while it was mild for 96% of the control group.The average±SD of the total pre-surgery score was 67.5±20.3 (95% confidence interval [CI]:63.13-71.88). The average post-surgery scores were 37.9±21.4 (95% CI: 33.24-42.48) and 37.25±23.9 (95% CI: 32.19-42.33) at 3 and 6 months,respectively (p<0.001). The average score for the control group was 31.2±13.2 (95% CI: 28.6-33.8) and was significantly different from the post-surgery groups (p=0.03). CONCLUSIONS: Quality of life was reduced in children with a surgical indication for symptomatic adenotonsillar hypertrophy, while it was significantly improved after the surgery.

Evaluación de la calidad de vida antes y después de la adenotonsilectomía en niños con hipertrofia de amígdalas y/o adenoides / Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids

Introducción. La adenoamigdalectomía es la intervención más frecuente en otorrinolaringología. La principal indicación son las alteraciones obstructivas de la vía aérea superior asociadas con hipertrofia de amígdalas y/o adenoides. Objetivos. Describir las diferencias en la calidad de vida antes y después de la adenoidectomía y/o amigdalectomía y en comparación con un grupo de niños sanos. Población y métodos. Se enrolaron niños de entre 1 y 17 años de edad internados para cirugía programada entre julio de 2012 y abril de 2014. Se comparó con un grupo control de niños de la misma edad. Se utilizó una encuesta validada en el idioma español (OSA-18), especialmente diseñada para relacionar apneas obstructivas del sueño con calidad de vida, en pediatría. Resultados. Se evaluaron 85 pacientes quirúrgicos y 100 niños sanos del grupo control. Se halló un impacto sobre la calidad de vida leve en 37,6 % de niños, moderado en 32,9 % y grave en 29,4 %, mientras que en el grupo control fue leve en el 96 %. El promedio ± DE de puntaje prequirúrgico total fue de 67,5 ± 20,3 (IC 95 % 63,13-71,88). Los promedios posquirúrgicos fueron 37,9 ± 21,4 (IC 95 % 33,24-42,48) y 37,25 ± 23,9 (IC 95 % 32,19-42,33) a los 3 y 6 meses, respectivamente (p < 0,001). El puntaje promedio en el grupo control fue 31,2 ± 13,2 (IC 95 % 28,6-33,8) y difirió significativamente con los grupos posquirúrgicos (p= 0,03). Conclusiones. Se observó una disminución de calidad de vida en niños con indicación quirúrgica por hipertrofia adenoamigdalina sintomática y un beneficio significativo sobre esta luego de la intervención.

Introduction. Adenotonsillectomy is the most common surgical procedure in otolaryngology. The main indication for this procedure is upper airway obstruction associated with hypertrophic tonsils and/or adenoids.Objectives. To describe the differences in quality of life before and after an adenoidectomy and/or tonsillectomy and compare it with that of healthy children.Population and Methods. All children aged 1 to 17 years old hospitalized for an elective surgery between July 2012 and April 2014 were enrolled. They were compared to a control group of children in the same age range. The survey used was validated in Spanish (OSA-18) and has been especially designed to establish a relationship between obstructive sleep apnea and quality of life in pediatrics. Results. Eighty-five surgery patients and 100 healthy control children were assessed. The impact on quality of life was mild in 37.6 % of children, moderate in 32.9 %, and severe in 29.4 %, while it was mild for 96 % of the control group.The average ± SD of the total pre-surgery score was 67.5 ± 20.3 (95 % confidence interval [CI]: 63.13-71.88). The average post-surgery scores were 37.9 ± 21.4 (95 % CI: 33.24-42.48) and 37.25 ± 23.9 (95 % CI: 32.19-42.33) at 3 and 6 months, respectively (p < 0.001). The average score for the control group was 31.2 ± 13.2 (95 % CI: 28.6-33.8) and was significantly different from the post-surgery groups (p = 0.03). Conclusions. Quality of life was reduced in children with a surgical indication for symptomatic adenotonsillar hypertrophy, while it was significantly improved after the surgery.

Paniculitis lipoatrófica y alteración del cromosoma 10 / Lipoatrophic panniculitis and alteration of chromosome 10

La paniculitis lipoatrófica (PL) es una enfermedad rara que afecta principalmente a mujeres y niños. Su forma de presentación consiste en múltiples placas eritematosas en las extremidades, que resuelven con atrofia subcutánea. Frecuentemente el cuadro se asocia con fiebre y trastornos autoinmunes. Presentamos una paciente de sexo femenino, de 8 años de edad, con síndrome febril de un mes de evolución asociado a atrofia y pigmentación en el dorso de las manos y piernas, edema semiduro simétrico del dorso de los pies pies y cara posterior del tercio distal de las piernas, nódulos en la cara posterior de las piernas, parestesias y limitación a la deambulación. Estudios complementarios: enzimas hepáticas, eritrosedimentación, proteína C reactiva, fibrinógeno y ferritina elevadas y FAN positivo; en la ecografía de partes blandas (pies, piernas y dorso de manos) presencia de múltiples imágenes pseudonodulares compatibles con focos de fibrosis; en la biopsia de piel (lesión nodular) hallazgos de paniculitis lobular; cariotipo 46XX, con anomalía estructural y deleción del brazo largo del cromosoma 10. Presentamos este caso, por tratarse de una patología infrecuente, con un sólo caso descripto en la literatura asociado a alteraciones del cromosoma 10, y por el desafío diagnóstico que ocasionó al plantel médico.

Lipoatrophic panniculitis is a rare disease affecting mostly women and children. It presents as multiple erythematous plaques on the extremities resolving with subcutaneous atrophy. Affected patients are often febrile and may have associated autoimmune phenomena. We report an 8-year-old girl, with 30-day history of fever, with atrophy and pigmentation on the back of the hand and legs, semi-hard symmetrical edema in the back of feet and distal posterior third of legs, and nodules on the back of the legs, paresthesia, and impaired deambulation. Complementary studies revealed elevated liver enzymes, fibrinogen, ferritin, VSG and CRP; positive ANA; multiple pseudonodular images compatible with focal areas of fibrosis in ultrasound of feet, limbs and back of the hands; skin biopsy (performed on a nodule) showed a lobular panniculitis; the chariotype was 46XX with structural anomaly and deletion of long arm of chromosome 10. We report this case because of its infrequent nature, with only one case reported in medical literature associated to chromosome 10 anomalies, and the diagnostic challenges that it represented to medical staff.